Provider Demographics
NPI:1407597511
Name:FADAYEL, STEPHANIE (DO)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:FADAYEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 CIRBY WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4420
Mailing Address - Country:US
Mailing Address - Phone:916-789-1798
Mailing Address - Fax:916-789-0889
Practice Address - Street 1:902 CIRBY WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4420
Practice Address - Country:US
Practice Address - Phone:916-789-1798
Practice Address - Fax:916-789-0889
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A23819208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics